Radiology Authorization Specialist 8/17/2016
Dana-Farber Cancer Institute
Located in Boston and the surrounding communities, Dana-Farber Cancer Institute brings together world renowned clinicians, innovative researchers and dedicated professionals, allies in the common mission of conquering cancer, HIV/AIDS and related diseases. Combining extremely talented people with the best technologies in a genuinely positive environment, we provide compassionate and comprehensive care to patients of all ages; we conduct research that advances treatment; we educate tomorrow's physician/researchers; we reach out to underserved members of our community; and we work with amazing partners, including other Harvard Medical School-affiliated hospitals.
The Patient Access Specialist reports to the Supervisor of Access Management and is responsible for timely completion and accuracy of assigned daily tasks. These functions include, but are not limited to collecting demographic and insurance information, insurance eligibility and benefit verification, obtaining referral and authorizations for patients receiving care at the Dana-Farber Cancer Institute and its partnering facilities, as applicable.
* Obtains authorizations for high tech imaging for existing and new patients, financial, and other relevant personal information into the hospital information system.
* Utilizes work queue reports to maintain consistent organization of referral and authorization work assigned.
* Verifies insurance eligibility and benefits using automated eligibility systems, payer websites, telephone interactions with payers and patients.
* Updates patient insurance and demographics information as needed. Understands the revenue cycle implications of insurance change and notifies the appropriate revenue cycle teams of insurance changes.
* Understands payer radiology prior authorization guidelines and accurately submits prior authorization request for high-tech imaging.
* Reads, comprehends, and selects appropriate medical documentation to support radiology prior authorization request, modality, and frequency intervals.
* Identifies and escalates prior authorization request that do not meet guidelines.
* Maintains positive, proactive, open communication with clinical staff, patients, and team members throughout the radiology prior authorization process.
* Easily manages multiple authorization requests at once. Follows up on all prior authorization requests timely. Proactively escalated difficult cases and seeks resolution at least 72 hours in advance of a date of service.
* Re-prioritizes work to address add-on radiology scans.
* Ensures that documentation is clear, concise on all prior authorization requests.
* Follows-up on post-claim denials. Troubleshoots claim denial and works with revenue cycle team to resolve the issue.
* Completes assigned work queues, projects, and other duties as directed.
High School Diploma/GED required. 1-2 years of prior physician office or hospital registration or billing experience required. Knowledge of insurance coverage and referral, authorization policies preferred. Knowledge of physician or hospital registration or billing systems preferred; GE Centricity systems experience preferred. Strong understanding of Microsoft Office product suite.
Excellent customer service and communication skills, both written and verbal. Self starter with strong team player and leadership abilities. Strong analytical and problem solving skills. Ability to prioritize and meet pre-determined deadlines. Must be able to effectively multi-task, and have advanced technical skills, as appropriate.
Dana-Farber Cancer Institute is an equal opportunity employer and affirms the right of every qualified applicant to receive consideration for employment without regard to race, color, religion, sex, gender identity or expression, national origin, sexual orientation, genetic information, disability, age, ancestry, military service, protected veteran status, or other groups as protected by law.